Document Detail


Peripartum hypertension from pheochromocytoma: a rare and challenging entity.
MedLine Citation:
PMID:  16202853     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pheochromocytoma, a rare and usually curable cause of hypertension, is characterized by symptoms and signs related to increased catecholamine secretion. Pregnancy can elicit clinical manifestations of otherwise unrecognized pheochromocytoma. METHODS AND RESULTS: Four women, ranging in age from 27 to 37 years, were referred to the hypertension clinic with the following presentations: 1) a 35-year-old woman, diagnosed with gestational hypertension and headaches during the third trimester of her pregnancy and 5 months after delivery, was hospitalized with pulmonary edema. Echocardiography revealed severe dilated left ventricular (LV) dysfunction. Cardiac function was normalized after surgical resection of a pheochromocytoma from her left adrenal; 2) a 37-year-old woman suffered from preeclampsia, persistent hypertension and orthostatic hypotension after a cesarean section. A diagnostic work-up revealed a catecholamine-secreting paraganglioma in the retroperitoneum. The patient underwent a laparosopic resection of the tumor; 3) a 27-year-old woman suffered from hypertension and episodes of palpitations, sweating, and dyspnea in the first trimester of her pregnancy. An ultrasound revealed a 5-cm mass in the left adrenal. She underwent a left adrenalectomy at the 17th week of pregnancy, which confirmed the diagnosis of pheochromocytoma; 4) a 34-year-old woman, at the 26th week of pregnancy, presented with an acute loss of vision and blood pressure of 230/140 mm Hg. Fundoscopy showed papilledema with soft exudates in both eyes. Chemical studies were positive and imaging revealed a left adrenal pheochromocytoma. Despite aggressive medical treatment, fetal distress mandated a laparotomy at the end of the 28th week of pregnancy. A healthy newborn was delivered and resection of the adrenal tumor confirmed the diagnosis of pheochromocytoma. CONCLUSIONS: Although rare, pheochromocytoma can cause severe peripartum hypertension. Screening for pheochromocytoma, ideally with plasma-free metanephrines, should be considered in cases of peripartum hypertension.
Authors:
Yehuda Kamari; Yehonatan Sharabi; Adi Leiba; Edna Peleg; Sara Apter; Ehud Grossman
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  American journal of hypertension     Volume:  18     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-05     Completed Date:  2006-02-28     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1306-12     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Israel.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Gland Neoplasms / complications*,  diagnosis,  surgery
Adult
Echocardiography
Female
Humans
Hypertension, Pregnancy-Induced / diagnosis,  etiology*
Laparotomy
Magnetic Resonance Imaging
Pheochromocytoma / complications*,  diagnosis,  surgery
Pregnancy
Pregnancy Complications, Cardiovascular / diagnosis,  etiology
Pregnancy Complications, Neoplastic / diagnosis,  etiology
Retroperitoneal Neoplasms / complications*,  diagnosis,  surgery
Tomography, X-Ray Computed
Ventricular Dysfunction, Left / diagnosis,  surgery
Comments/Corrections
Comment In:
Am J Hypertens. 2005 Oct;18(10):1266-70   [PMID:  16202846 ]

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